Low Blood Pressure, Low Sodium, SIADH in Parkinson

[Thetans]

My dad has been dealing with low blood pressure, SIADH, and low sodium levels. In the mornings, his blood pressure is around 130/90, but after moving around, it drops significantly to about 60/40. His doctor recommended fludrocortisone to help stabilize his blood pressure, but he’s been struggling with the side effects. Has anyone experienced something similar or have any suggestions on alternative treatments or ways to manage these side effects? He is at his 7th year of Parkinson.

[park_bear]

Sounds like he might have orthostatic hypotension - loss of blood pressure when transitioning from sitting to standing position. Is that what is going on here?

_

SIADH - Syndrome of inappropriate antidiuretic hormone secretion

In this condition, the body retains water instead of excreting it normally in urine.

[Thetans in reply to park_bear]

Yes, most after he eats he will have a large dip in blood pressure. SIADH causes the body to hold excessive of water, causing low in sodium in the body which does not help with his low blood pressure.

[park_bear in reply to Thetans]

The medical term for loss of blood pressure after eating is postprandial hypotension. Discussion of postprandial hypotension here:

ncbi.nlm.nih.gov/pmc/articl...

"The drop degree of BP depends on the amount of food ingested and its contents, especially carbohydrate content. The hypotensive effect of a meal develops within 15 minutes, reaching its maximum and persisting up to 3 hours after the start of a meal. ...Nonpharmacologic approaches are a very cost-effective treatment strategy for patients with postprandial hypotension. Patients should eat small and frequent meals, reduce carbohydrate intake or consume high-carbohydrate foods before going to bed, while paying attention to the risk of low blood sugar and high blood sugar at night. Caffeine and water can reduce symptoms of postprandial hypotension. The diuretic effect of caffeine may counteract its vasopressor benefits."

You should also be on the lookout for supine hypertension - check his blood pressure while lying down in the evening to make sure it is not excessive.

[Thetans in reply to park_bear]

Thanks for the info.

[Eryl]

The body has a mechanism for keeping the ratio of sodium to potassium within limits. Are you sure that the problem isn't that he is low on potassium and the body is trying to compentate by lowering sodium?

[Thetans in reply to Eryl]

His potassium seems to be in a normal level.

[PalmSprings]

I have just started with Fludrocortisone. I do not really know yet if I have side effects but I will keep you in mind over the next two weeks as my doctor is monitoring me and we are going to see if I get the relief from the Orthostatic Hypertension and the low sodium levels that I have been dealing with for years. I have been diagnosed for 10 years. I will get back to you if I find out anything that I think would be relevant for you. Cheers

[Daughterdad75]

my dad is 76 and most mornings he wakes up and his blood pressure could be 90/60, could be lower could even be higher, but his cardiologist has him taken midodrine 5 mg as soon as he wakes up, he can take it again four hours later and if needed can take it again, four hours after that, this has helped dramatically with keeping his blood pressure more normal, sometimes he can a a bit high at night, but within a half an hour it always comes back down

[Thetans in reply to Daughterdad75]

Thanks for this info, we will speak to the doctor.